The Clinical and Pathological Course of Hepatitis B Liver Disease in Renal Transplant Recipients

Parfrey, Patrick S.; Forbes, R. D. C.; Hutchinson, Tom; Beaudoin, J. G.; Dauphinee, W. Dale; Hollomby, David J.; Rd, Guttmann

doi:10.1097/00007890-198405000-00008

Cited by 94 publications

(29 citation statements)

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“…[1][2][3]8,9,[24][25][26][27][28][29][30][31] The detrimental effects of HBV infection have become more evident with the improving overall survival of kidney transplant recipients, consequent to advances in the management of other complications. 5 There is increasing agreement that liver-related complications are common in HBsAg-positive kidney transplant recipients and may account for 37% to 57% of mortality.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5] The number of chronic HBV carriers exceeds 300 million worldwide, and up to 14% of renal allograft recipients in endemic areas are hepatitis B surface antigen (HBsAg) positive. 6,7 Progressive liver disease affects more than 80% of HBsAg-positive renal transplant recipients 8,9 and accounts for 37% to 57% of mortality.…”

Section: See Editorial On Page 1041 H Epatitis B Virus (Hbv) Infectiomentioning

confidence: 99%

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Preemptive lamivudine therapy based on HBV DNA level in HBsAg-positive kidney allograft recipients

et al. 2002

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Hepatitis B surface antigen (HBsAg)-positive kidney transplant recipients have increased liver-related mortality. The impact of lamivudine treatment on patient survival, the optimal time to start treatment, and the feasibility of discontinuing treatment have not been determined. This study examined these issues with a novel management protocol. Serum hepatitis B virus (HBV) DNA levels were measured serially in HBsAg-positive kidney transplant recipients, and lamivudine was administered preemptively to patients with increasing HBV DNA levels with or without elevation of aminotransferase levels. Outcomes of patients who underwent transplantation before or after institution of this preemptive management strategy (in January 1996) were compared. H epatitis B virus (HBV) infection is an importantcause of morbidity and mortality after kidney transplantation. [1][2][3][4][5] The number of chronic HBV carriers exceeds 300 million worldwide, and up to 14% of renal allograft recipients in endemic areas are hepatitis B surface antigen (HBsAg) positive. 6,7 Progressive liver disease affects more than 80% of HBsAg-positive renal transplant recipients 8,9 and accounts for 37% to 57% of mortality. 3,4,9 Life-threatening exacerbation of liver disease can develop in previously healthy HBV carriers. An optimal monitoring and treatment regimen for HBsAg-positive renal allograft recipients has not been defined.Lamivudine is a nucleoside analogue with proven efficacy in suppressing HBV DNA levels and ameliorating aminotransferase and histologic abnormalities in nonimmunosuppressed patients with chronic hepatitis B. 10,11 Short-term studies have shown virologic and biochemical efficacy in small series of renal transplant recipients. [12][13][14][15][16] We and others have reported favorable results with lamivudine in the treatment of fibrosing cholestatic hepatitis B, which hitherto has been associated with nearly uniform mortality. 17,18 However, many critical issues remain unresolved. It is not known whether patient survival can be Abbreviations: HBV, hepatitis B virus; HBsAg, hepatitis B surface antigen; ALT, alanine aminotransferase; HBeAg, hepatitis B e antigen.

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Section: Discussionmentioning

confidence: 99%

Section: See Editorial On Page 1041 H Epatitis B Virus (Hbv) Infectiomentioning

confidence: 99%

Preemptive lamivudine therapy based on HBV DNA level in HBsAg-positive kidney allograft recipients

et al. 2002

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“…Subsequently, Hattler et al demonstrated that a single transfusion of whole blood can provoke sufficient immune response to induce accelerated rejection of a skin graft from the blood donor (Hattler, 1966). This policy of with-holding pre-transplant transfusions was reinforced by growing concerns about the serious long-term consequences of transfusion-induced hepatitis in the immunosuppressed graft recipient (Parfrey, 1984).…”

Section: History Of Blood Transfusion Effect In Clinical Transplantationmentioning

confidence: 99%

Effect of Blood Transfusion on Subsequent Organ Transplantation

Kochhar¹,

Ghosh²,

Kochhar³

2012

Blood Transfusion in Clinical Practice

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“…The outcome of renal allograft recipients (RTx) is adversely affected by hepatitis B virus (HBV) infection (1)(2)(3)(4)(5)(6)(7)(8)(9). The magnitude of this problem is especially profound in endemic areas when greater than 10% of the general population are HBsAg-positive.…”

Section: Introductionmentioning

confidence: 99%

“…HBsAg-positive RTx demonstrate increased viral replication and increased severity of liver disease, consequent to the effect of immunosuppression (1)(2)(3)(4)(5)(6)(7)(8)(9)(22)(23)(24). Among liver allograft recipients, the development of lamivudine resistance is followed by resurgence of viral replication and transaminase levels (25).…”

Section: Introductionmentioning

confidence: 99%

Prospective Study on Lamivudine-Resistant Hepatitis B in Renal Allograft Recipients

Chan¹,

Tse

Tang

et al. 2004

American Journal of Transplantation

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The natural history of lamivudine-resistant hepatitis B virus (HBV) infection in renal transplant recipients (RTx) is unclear, despite its increasing incidence. Twenty-nine HBsAg-positive RTx with rising HBV DNA received lamivudine therapy. The course of lamivudine-resistant HBV infection was studied prospectively. During 68.7 ± 12.5 months of follow-up, 14 (48.3%) patients developed lamivudine resistance, at 10-35 months (mean 16.9 ± 7.0). All showed mutant sequences at codons 552 and 528 of the YMDD motif, while 13 patients demonstrated wild-type sequence at codon 555. Lamivudine resistance was unrelated to patient demographics, HBeAg status/sero-conversion, or genotype. Following resistance, HBV DNA and alanine aminotransferase showed an initial increase followed by spontaneous gradual reduction. The subsequent peak HBV DNA was lower (1.26 ± 1.09 × 10 9 vs. 6.26 ± 12.23 × 10 9 copies/mL, p = 0.011), while that of alanine aminotransferase was higher (196 ± 117 vs. 77 ± 47 il/l, p = 0.005), compared with pretreatment levels. Post-resistance hepatitic flare occurred in 11 (78.6%) patients. This was transient in four (36.4%), but became chronic in six (54.5%) patients. Decompensation was noted in one patient during this flare, but all survived. We conclude that drug resistance is prevalent in lamivudine-treated RTx. Despite a lower ensuing peak viremia compared with baseline, hepatitic flare is common. While most patients have spontaneous resolution, a minority may develop potentially fatal decompensation during the preceding exacerbation.

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The Clinical and Pathological Course of Hepatitis B Liver Disease in Renal Transplant Recipients

Cited by 94 publications

References 0 publications

Preemptive lamivudine therapy based on HBV DNA level in HBsAg-positive kidney allograft recipients

Preemptive lamivudine therapy based on HBV DNA level in HBsAg-positive kidney allograft recipients

Effect of Blood Transfusion on Subsequent Organ Transplantation

Prospective Study on Lamivudine-Resistant Hepatitis B in Renal Allograft Recipients

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